Organization
COUNTRYSIDE CLINIC OF CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY DEJTIRANUKUL D.C. (OWNER)
(314) 496-6030
Entity
Organization
Contact information
Practice address
990 BELVEDERE DR STE B, LEBANON, OH 45036-1193
(513) 836-8844
(513) 836-8845
Mailing address
990 BELVEDERE DR STE B, LEBANON, OH 45036-1193
(513) 836-8844
(513) 836-8845
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4008
OH
Other
Enumeration date
02/23/2014
Last updated
11/26/2019
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